Vital Signs

Your Brain’s Gotta Recalibrate

Episode Summary

Hearing loss is common. Physicians like Dr. Sean McMenomey are not. He shares his unlikely story from truck driver to surgeon, and the joy of restoring hearing using cutting edge technology.

Episode Transcription

Season 1  Episode 5 - Your Brain’s Gotta Recalibrate

Feature:  Dr. Sean McMenomey, MD and Anthony DiCarlo

Narration:  Maggi van Dorn 


Dr. Sean McMenomey: You can't develop speech if you can't hear, pure and simple. When someone comes to me with hearing loss, I really don't ever have to say, I'm sorry, there's nothing I can do for you. I have nothing out there. My name is Sean McMenomey. I'm a professor of otolaryngology, head and neck surgery here at NYU Langone Health.

Maggie van Dorn: What good is hearing - if we never learn to listen? As a physician, Dr. Sean McMenomey’s job is to help people who were born deaf, or those who lose their hearing, regain this sense. But he has also spent his life and his career listening. And talking. 

SM: I was a kid and I was helping run a trucking company with Teamsters that were in their fifties and sixties. And you had to be able to communicate to those folks and that's where I learned to cut my chops on that and you know, I can talk to anybody. 

MvD: He can also operate on almost anybody. One of the great joys of his specialty is that he treats patients of all ages, from 6 months to 96 years. And that includes people right smack in the middle, like Anthony DiCarlo.  

Anthony DiCarlo: So about five years ago I got these, kind of like these big beeps kind of like being underwater in my right ear. And it was like pop, pop, and then I couldn't hear anything. 

MvD: Anthony’s hearing loss happened suddenly, and out of nowhere. The technology that could return it to him, however, had been fine-tuned for decades. It’s changed the lives of countless people in profound and lasting ways.  

AD: My grandmother said to me, God rest her soul, in life, things are going to happen to you. You don't understand why, but then something will come to you and you will understand. And that really says it all. 

MvD: From SiriusXM and NYU Langone Health, this is Vital Signs, where medicine is made personal. I'm your host, Maggi van Dorn.

MvD: Dr. Sean McMenomey is an otolaryngologist, which is a long word for an ear, nose and throat doctor. But really, this specialty could be called ear, nose OR throat, because physicians in the field tend to be highly specialized in one of the three. In Dr. McMenomey’s case, that would be the ear and its immediate surroundings. It’s a small part of the body, and yet it is incredibly vital, and complex. 

SM: If you tell people you're a skull based surgeon, nobody knows what that is, but it's really where the ear meets the brain. And that's really my entire life, is this area about the size of your fist on the side of your head. So I take care of ear problems, hearing problems, and I take care of tumors that exist inside the skull that interact with the nerves of the ear. So things like acoustic neuromas and meningiomas and things like that. And it's very, very, sub-specialized, it's not really, it has nothing to do with general otolaryngology. 

MvD: Growing up in Northern California, Dr. McMenomey also had nothing to do with otolaryngology, and wanted very little to do with school in general. A self-described middle of the road student, he focused primarily on sports and did the minimum amount of work required.

SM: I didn't really have much confidence in my academic abilities, cause really I had never put them to the test. I don't think I really did much homework in high school. And I went to junior college, not really knowing what I wanted to do. I drove a tow truck and eventually ended up working for a, for a larger trucking company. And, uh, it was kinda just going through the motions for a while.

MvD: But those motions would prove meaningful for Dr. McMenomey. Though he wasn’t so sure of himself as a student, working for that large trucking company helped him develop and refine skills he uses to this day.

SM: Starting off, out on the loading dock, because they aren’t going to put you immediately in a truck. And I ended up becoming a manager of the loading dock, still going to college, putting myself through junior college. And then I got pulled into management of the trucking company and I was all of 20 years old, something like that. I was a pretty young kid. That experience, I think, helped shape who I am today. So much of being a doctor is about being able to communicate with people and on a real level. I was a kid and I was helping run a trucking company with Teamsters that were in their fifties and sixties. And you had to be able to communicate to those folks and convey what we needed to get done as a team and make that happen. And that was a little rough at first. But I learned how to do it so it was pretty seamless once I figured out how to do that. And you take those same skills and you apply them to medicine. Because as a patient, I want a teammate with me. We have to go into this, whatever it is, surgery or, or plan of care, we have to go into it together, ‘cause that's gonna lead to the best outcomes. And so I learned really from that experience, how to, how to talk to people in real words and not use highfalutin medical terms. Cause that really doesn't play very well. I can talk to anybody. So when I see a patient comes in the office that's a trucker, I can say: Hey, you know, I was a trucker! And they immediately light up and their eyes change and they're like, oh, I can talk to this guy. And I'm like, yeah, you can talk to me.

MvD: Medical school might seem like quite a leap for a college-aged kid running a trucking company, but it had always been in the back of his mind. Dr. McMenomey’s father applied decades before, but never ended up going because of World War II. He met a few doctors through his trucking work, and realized something about them.

SM: I didn't think they were any smarter than me or I was any dumber than them. And I thought, well, maybe this is the time in my life to put it to the test and see if I could do it. And so I really flipped a switch internally and just said, I'm going to give it a shot. 

MvD: He put himself through college in San Francisco, and then medical school in St. Louis. For someone whose previous job required organizing trucking routes for maximum efficiency, Dr. McMenomey went slightly off the beaten path when he chose his specialty. 

SM: During medical school, you have to ask yourself some soul-searching questions about who you are and what you want to do and how you see yourself in medicine. And I knew that I wanted to be a surgeon and I wanted to fix things. And for me, the anatomy of the head neck, it's so complicated. And also I like the fact that you can interact with and operate on adults and kids, men, and women. That's really how I chose otolaryngology was the anatomy was fascinating and it didn't cut me off from any segment of the population, as far as being a patient. 

MvD: Hearing is one of the most effortless things we do. If everything works as it should, you don’t have to try to hear; for most of us, it just happens. Which is sort of contradictory to everything going on behind the scenes.  

SM: So sound waves come into the ear and they hit the eardrum and the eardrum moves, ideally. And it vibrates the bones of the middle ear, which then translates that acoustic signal into vibration of the fluid of the inner ear, the cochlea. And that makes some little hair cells bend, fire off an electrical charge that goes through the nerve, and ends up in the auditory cortex of the brain. When you start talking auditory cortex with patients sometimes their eyes glaze over and that, you know, they're done. So I, I talk about a car and I talk about a conductive hearing loss and a sensory neural hearing loss, which are two very different types of hearing loss. And the car comes in where I say, you know, if you have a conductive hearing loss, it's often like you have the best engine in the world. Think of the engine as your inner ear. And you could have the best engine in the, in your car. But if your gas pedal is rusted stuck, it doesn't matter how good the engine is, cause you can't push the pedal. And that's one example of a type of conductive hearing loss called otosclerosis. And they're like: Oh yeah, my linkage is stuck. And I go: Yeah, I can go in and I can free up the linkage and I can make that engine do what it's supposed to do. A cochlear implant on the other hand is that the linkage is fine, but the engine is either out of way out of tune or blown up. And I can go in and I can put a cochlear implant in and, and fix the engine. And that makes sense.

MvD: There’s a difference between being born deaf, and losing your hearing later in life. Congenital deafness, which is present at birth, can often be can be hereditary, or the result of a number of other factors. Acquired hearing loss can happen at any age, and is usually caused by infections, head injuries, excessive noise exposure, aging, and ear wax. Luckily, Dr. McMenomey and his colleagues have tools to correct most hearing loss, regardless of its origin.  

SM: We might do something called an ossiculoplasty , which I'd call putting a fake ear bone in. And that's for a conductive hearing loss. For a sensory neural hearing loss, that's where we get into hearing aids or cochlear implants or brainstem implants. 

MvD: Around 15 percent of U.S. adults - that’s 37.5 million people - have some trouble hearing, according to the National Institutes of Health. Hearing loss has been associated with cognitive decline in older adults, higher rates of depression, and delayed language development in children. It’s something Dr. McMenomey has witnessed firsthand.

SM: I had a friend who is still a good friend who had a sister, who has a sister and she was profoundly hearing impaired. And unfortunately, at the time she was really thought to be, um, a slow person. She was not. She was nearly deaf. And that unfortunately happened a lot back then. And I didn't know what to make of any of that. I just thought, as everybody else did, that, you know, she was slow and impaired. But when I found out she was hearing impaired and that was really the cause and it was diagnosed so late, that really had a, an impact on me. I just thought, wow, that's so sad. And I was just a dopey kid at that point. I, I didn't know. But that had a definite impact. Moreso once I got into the profession of taking care of people with hearing loss, I just always thought about that. And it was one of the things that drove me to push for early diagnosis and early intervention in kids with hearing loss. Whether it's cochlear implants or hearing aids, whatever they need is this is too great a country to let that happen.


MvD: People of all ages with hearing loss can benefit from assistive devices, like hearing aids. Unfortunately, they don’t work for everybody. Which is when Dr. McMenomey gets to have some fun.

SM: The cochlear implant technology is amazing. It's life changing. It's by far the happiest thing that I do as a doc. It changes lives for the better every day. And what it is, is an internal and an external piece. The external piece is a microphone and a small microcomputer. And that brings the sound in through the microphone, just like a hearing aid would, and it changes it into electrical signal and it pushes that electrical signal through the skin, intact skin, using radio frequencies. The internal piece, that internal piece that I put in surgically is basically a small internal chip and an electrode that I thread directly into the cochlea. And this is the part that's so fascinating, that's changed so much since I started doing it. Boy, the first cochlear implant, the processor (which is what we call the external device that you wear on the outside) that was as big as a 12 volt battery. Now you jump forward to 2020, it’s about the size of a small poker chip that they wear on the outside, which is amazing, right? NYU has been integral in developing a number of these electrodes. We can put the electrode in the cochlea, in a subsegment of the cochlea (we're talking sub millimeters) and in a lot of patients, we can preserve what hearing they had coming in. So it used to be, that was never something that we could do. 

MvD: Not only can Dr. McMenomey preserve existing hearing in these patients, but advances in cochlear implant technology also make it so that recipients can hear more efficiently at different frequencies, allowing them to better appreciate music, for instance. Because even though a cochlear implant can help a person hear with incredible detail, the sounds aren’t exactly the same. 

SM: If they expect to hear quote unquote, normally on the day of activation, the day we turn the cochlear implant on, that's not going to happen. The brain has to learn how to hear this new way. It's never heard electrically. It's heard with acoustic stimulation, never with an electrode that's in the cochlea stimulating it electrically. So their brain has to figure this out. And the amazing thing about the brain is it does figure it out. People will tell you that have cochlear implants that it sounds a little bit more mechanical, might sound like that voice that comes out of Alexa, or comes out of your computer, but it changes over the course of their implant. So, someone that, that says, boy, it sounds very mechanical and very bizarre at one month post-op at six months, post-op has a very different impression of how that sound is.

MvD: And just as quality of sound improves for cochlear implant patients, so too has the procedure itself.  

SM: It used to be a very long operation, three to four hour operation where patients stayed in the hospital for a week. Now patients are in the operating room for about an hour. They go home the same day. And their age range is amazing too in cochlear implants. The youngest patient that I've personally operated on is six months old, and the oldest for me personally is 96.  

MvD: Six months might sound young. But for babies born deaf or with hearing loss, it’s actually the perfect time to receive an implant. 

SM: You can't develop speech if you can't hear pure and simple. So children that are born deaf that are never identified or taken care of or treated with either hearing aids or cochlear implants will not develop speech. The brain has a period of plasticity, which allows the brain when a young brain to receive new stimulus and fuse that stimulus beautifully. And once that plasticity kind of goes away and it goes away quicker than you would think it goes away by age four to five to six. It’s never the same. So that's why we push for early cochlear implantation. We're implanting kids now under one routinely and they do phenomenally. But you implant that same child, if you had waited until they were eight or nine or 10, uh, you won't see the same kind of benefit, same results at all.

MvD: Most of us probably know someone who has lost some amount of hearing. It is one of the most common medical problems, especially in older people. To some extent, we expect it to happen slowly as we age. That was not the case, however, for Anthony DiCarlo.  

Anthony DiCarlo: So about five years ago I was sitting believe it or not, and watching a game in August, happened to be a Met fan. And I got these kind of like these big beeps kind of like being underwater in my right ear. And it was like pop, pop, and then I couldn't hear anything.  

MvD: School superintendent Anthony DiCarlo was 54 years old when a series of beeps changed his life. 

AD: So I kind of played it off, you know, maybe it was an ear infection or if I had gotten water in my ear from just coming out of the shower. And I said it was no big deal. Couple of hours later, my wife comes home and I told her, you know, this is what happened to me, and I still can't hear. At which point she said, well, maybe it's a good idea to call the doctor. 

MvD: Sudden hearing loss in one ear can be temporary or permanent. It can be a sign of an underlying health emergency - like a stroke or a brain tumor - or the result of an infection. Only proper testing, and time, can tell.  

AD: So I went to the nearby local emergency room and explained what had happened. And they said we need to give you a scan to rule out a stroke. So, you know, I got the scan done. Thank God, of course, there was no stroke. Came back in and the covering doctor said I'm going to give you some antibiotic and whatever. Maybe it's an infection, but I think you need to follow through with an ENT specialist. 

MvD: Further testing confirmed that Anthony had, in fact, become suddenly - and profoundly - deaf in his right ear. Treatment for a possible infection proved ineffective. One doctor led to another, and then to another, and eventually he found himself in the office of Dr. Sean McMenomey. 

SM: So Anthony came to me and he suffered what we refer to as a sudden sensory neural hearing loss. Idiopathic, sudden sensory neural hearing loss. So that's a mouthful, right? What it means is he had a catastrophic failure of his cochlea in one ear and it's unfortunately fairly common. If this happens, it's a medical emergency. You need to get into an ear doc and let them see you early because there are treatments we can use if we see you early enough. And in Anthony, we gave him everything we have available to us. 

AD: Dr. McMenomey said, um, Anthony, I hate to tell you this, but 50% of hearing loss, we don't know. It wasn't like, you know, you had some kind of a brain injury or, you know, you were in the war or something happened. It could be a virus. He said, now the option is up to you. You can do nothing and see if it comes back or, I can shoot you today over the next couple of weeks with steroids to see if we can get it back. And that's what I did. Um, I went down for three weeks in a row every week and got this huge needle in my ear to try to get it to come back. But it didn’t.  

MvD: At that point, Dr. McMenomey explained the options. First, Anthony could do nothing. And live with profound one-sided deafness. He could try a treatment called hyperbaric oxygen therapy, which can help increase the supply of oxygen to the ear, but this approach doesn’t usually work. Or, he could go through a few months of testing to see if he qualified for a cochlear implant. 

AD: And it’s interesting because I didn't even think about it. I was like, let's just move forward and do it. But it is scary. I'm not going to tell you it's not. I think half the battle is how you emotionally get ready to handle it. Or in some cases not handle it. The scary part is when you go into surgery, right? I mean, I, you just don't know when you come out, if what it's going to be like, right. You're scared. I mean, are you going to, actually, is it going to be successful. I mean, how successful will or will it not be? Did you make the right decision? The day that we are having the operation, there's a snow storm. I had gotten a car service to go down and of course you could imagine a snow storm going into New York City.  I had to be there, like, I think I want to say it like 8:45 in the morning. I literally got up, out about five blocks before NYU and I actually ran to make sure that I got there on time. 

MvD: Anthony waited the necessary few weeks after his surgery for the incisions to heal, and for swelling to go down. He had only been deaf in his right ear for a few months before receiving a cochlear implant. And still, the emotions were raw.

 AD: Once that device goes on and all of a sudden bang your hearing goes back, you're like: It was worth every, every bit of it. And then when I got connected, those first couple of days people sounded like munchkins, um, because your brain's gotta recalibrate. And I learned also how to sit in rooms, even though I do have the implant, I learned how to sit so that I make sure that I'm in a situation where I can hear everybody. It's not perfect. It never will be perfect. I mean, if I'm at a large group gathering or I'm at a game, or I'm at a concert, it's not easy. Because I'm trying to block out all the background noise to get as much hearing into that cochlear ear as I can. But you know, those situations I know will be difficult at times. But what I learned from this and Dr. McMenomey, he shared it, is because I made this decision right away to do it and not wait more months or a year or two, the connection to the brain really clicked much quicker. 

 MvD: What also clicked for Anthony was what his experience with hearing loss would mean to others. A lifelong educator, Anthony was a school principal at the time of his sudden hearing loss.

 AD: My grandmother said to me, God rest her soul, in life things are going to happen to you. You don't understand why, but then something will come to you and you will understand. And that really says it all. I have to tell you as somebody who wasn't born with a disability now that has a disability, I've kind of embraced it. I've come to understand that things in life happen for a reason. I went back to school about three weeks later and I was sitting in my office and the teacher of the deaf came in with, uh, two students who had cochlear implants also. They gave me this beautiful card. Of course they could now see my cochlear implant. And one of the boys turned to me and said, Oh, Mr. DiCarlo, that means now someday I can become a principal. Here's somebody, you know, at the age of 54 who now becomes deaf, but yet my journey has allowed me to open it up to make kids understand you can do anything in life that you can.

MvD: For Anthony, deafness was unavoidable. But for most people, hearing loss CAN be minimized with protection and care.  

SM: It starts with education. Noise protection is a function of two things: How loud is the noise and how long are you exposed to it? So it's occupational, it's hobby, in my case going to concerts, listening to loud music. If you come out of a concert and your ears are ringing, as mine did a million times, that's your body talking to you. And just like it talks to you if you have headaches that don't go away, you need to go see your doc and talk about your headaches. If your elbow constantly hurts, you've got to go talk about, you know, your tennis elbow. If your ears are ringing, it's a sign that something's going on that’s not right. I've walked by construction sites and I just, it just pains me to see the folks doing that without hearing protection. And I've stopped and I've, I've, I've butted in. And I said, you know, I'm an ear doctor. I know it's none of my business, but I really wish you would wear some. They’re like, Oh, is it really important doc? And I go, yeah, it's important, man.

MvD: Dr. McMenomey actively preaches the gospel of ear health, and springs to action in the name of it.  For the last few years, he and his colleague, Dr. Thomas Roland, have traveled to Africa to treat a common - and benign - condition that - if ignored - can have devastating effects.

 SM: Cholesteatoma is a very frequent diagnosis here. We see it all the time. So basically, a benign skin cyst of the ear that can cause hearing loss and cause ear infections and it's treatable day surgery. Over there, it's a life-threatening disease and people die every week from cholesteatoma in Africa. and it's, it doesn't have to happen.

 MvD: Dr. McMenomey and Dr. Roland plan to establish the first ever fellowship program for ear surgery in Africa, and to train doctors in Uganda so they can better care for their patients on their own.

SM: Basically we want to put us out of business over there. We don't want to go over there and do the surgery. We want to train them how to do the surgery. How to identify the patients. We've just begun the first newborn to identify these kids at birth and then get them in this pipeline to get implanted. It's all about education and getting the docs over there and the folks aware of cochlear implants and what it can do.


MvD: After spending decades helping other people protect and restore their hearing, it took a global pandemic to for Dr. McMenomey to realize - he could have done better to preserve his own.

 SM: I went to too many Stone concerts Led Zeppelin, and I used to come out of concerts, um, just ears ringing, like crazy. Well, you, we need to listen to our bodies. And that was my body telling me that was way too loud for way too long. And I didn't listen to it. And I got hearing loss as a result.

(news clips about COVID-19 mask wearing)

SM: With this whole COVID thing. Everybody wearing masks. I was having a great deal of difficulty hearing patients with masks on as their doctor. So I followed my own advice. I went and got a hearing test. And actually for the past month and a half, I have now worn hearing aids. It's amazing. I had no idea, because it happens so slowly, what I was missing out there. It's amazing. It's really amazing. I am no longer struggling to hear patients with their masks on, in my office with the air conditioner. It used to be the first thing I had to do was walk into the room and turn the air conditioner off and make sure the window on First Avenue was closed. Now I don't have to do that anymore. I can stream Sirius XM through my phone, which I do every single day. I've listened to it through my hearing aids. And I can't tell you how many times since I've got them, I talked to a patient, all of a sudden, I've got all the street cred in the world. And now I speak with authority of not only being someone that knows about them, but someone that wears them.

MvD: While the area of the body Dr. McMenomey treats is small, the impact he has had on his patients’ lives is enormous. It has transcended generations, cultures, and borders. He has given the gift of hearing to countless people, and yet, considers himself to be most fortunate of all.

SM: If you can go through life and be fulfilled and love what you get up every day and love what you do. And after all these years, I still do. If you can do that, whatever it is, trucking, accounting, radio producing, whatever it is, I think you're pretty lucky.  For me, I guess, I got lucky. I love the field, I love the patients. And you just draw on everything. All life experiences are drawn into taking care of every patient.

VO: Vital Signs is a co-production of NYU Langone Health and SiriusXM. The podcast is produced by Jim Bilodeau, Julie Kanfer, Rob Schulte and Keith King with sound design by Jim Bilodeau and writing from Julie Kanfer. SiriusXM’s executive producers are Beth Ameen and me, Maggie van Dorn in partnership with Allison Clair and Jim Mandler at NYU Langone Health. Don't miss a single episode of Vital Signs and subscribe for free wherever you listen to podcasts. To hear more from the world-renowned doctors at NYU Langone, tune in to Doctor Radio on SiriusXM channel 110 or listen any anytime on the SiriusXM app. For the Vital Signs podcast. I’m Maggie van Dorn. Join us next time as we bring you the stories of medicine made personal.